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Closing Keynote, February 11, 2019
Susan B, Hassmiller, PhD, RN, FAAN, Senior Adviser for Nursing, Robert Wood
Johnson Foundation (@suehassmiller)
Technology and the Human Connection: A
Personal Perspective
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Susan B. Hassmiller, PhD, RN, FAAN
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Describe my husband’s hospital stay in the intensive care
unit
• Describe how a positive patient experience is integral to
building a Culture of Health
• Make the business case for cultivating positive patient
experiences
• Share best practices for improving the patient experience
• Discuss the need to improve the caregiver experience
Agenda
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• Describe how promoting well-being and positive patient
experiences are part of building a Culture of Health in the
U.S.
• Outline the business case for enhancing the patient
experience and share best practices for improving the
patient experience
• Describe ways to reduce caregiver suffering at the
individual, team, organizational and systems level
Learning Objectives
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Bob and Me
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Bob and Me
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• Technology
• Paperwork
• Staffing ratios
• Personal issues
• Work culture
My ICU Observations
Compassionate care is not always the norm
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• Understand and agree with
the care being provided
• Have ample opportunities to
offer input
• Be able to express hopes and
fears
• Be understood and
acknowledged
Patients and Their Families Need to:
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The Nurses Who Cared for Bob and Me
Kathy and Abby with me at RWJF
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We, as a nation, will strive together to build a Culture of
Health enabling all in our diverse society to lead healthy
lives, now and for generations to come
RWJF Vision: A Culture of Health
Includes consumer
experience with care
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• ACA mandated hospitals would
be reimbursed on scores that
measure clinical care and
patient experience
• Hospitals are rewarded or
penalized based on their
patient experience scores
Patient Experience and Quality
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When patients believe they have a good care experience,
health care organizations have:
• Lower re-admission rates
• Shorter lengths of stay
• Fewer hospital-acquired conditions
• Higher Patient Safety Indicator scores
• Higher Patient Engagement scores
Costs decrease and outcomes improve
Making the Business Case
Mark Smith et al., eds. Best Care at Lower Cost: The Path to Continuously Learning
Health Care in America Washington, DC: Institute of Medicine, 2013
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• A 55 study meta-analysis found that patient experience is
positively associated with clinical effectiveness and patient
safety*
• Two studies found that hospitals with better patient
experience scores have higher quality measures for acute
myocardial infarction and aspects of surgical care**
The Evidence
*Doyle, Cathal, Laura Lennox, and Derek Bell. "A systematic review of evidence on the links between patient
experience and clinical safety and effectiveness." BMJ open 3.1 (2013): e001570
**Lyu H, Wick EC, Housman M, Freischlag JA, Makary MA. Patient satisfaction as a possible indicator of
quality surgical care. JAMA Surg. 2013;148(4):362-367
**Glickman SW, Boulding W, Manary M, et al. Patient satisfaction and its relationship with clinical quality and
inpatient mortality in acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3(2):188-195
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Higher
patient
experience
scores
Better
patient
follow-up
Better
teamwork,
leadership,
and quality
More new
and repeat
visits
Fewer
physicians
sued
The Evidence
Mehta, Shivan J. "Patient satisfaction reporting and its implications
for patient care." AMA journal of ethics 17.7 (2015): 616
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--The Beryl Institute “Consumer Perspectives on the Patient
Experience 2018”
Patient experience based on what
consumers shared is not a nice thing to
do, but rather it is a tangible and
practical commitment that will have both
an immediate and lasting impact on
organizations
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Positive and Negative Experiences
The Beryl Institute “Consumer Perspectives on the Patient Experience 2018”
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Compassionate Connected Care Model
Clinical Excellence
Connecting clinical excellence
with outcomes
Operational Efficiency
Connecting efficiency with
quality
Caring Behaviors
Connecting behaviors with
action
Culture
Connecting mission, vision and
values with engagement
Compassionate
Connected Care
Dempsey, Christina. The Antidote to Suffering: How Compassionate Connected Care Can
Improve Safety, Quality and Experience. New York: McGraw Hill Education, 2018
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The provision of exceptionally skilled clinical care
In an environment that is efficient and effective
By engaged and resilient caregivers
In a culture driven by a shared purpose to achieve the
optimal outcome for all involved
The Pathway to Compassionate Care
Dempsey, 2018
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• Interviewed 25 nurse leaders
on best practices to improve
patient experience
• Engaging families resulted in
increased patient experience
scores and decreased
lengths of stay and
medication errors
Journal of Nursing Administration
Article
Hassmiller, Susan B. and Ani Bilazarian. “The Business Ethics and Quality Case for
Consumer Engagement in Nursing” Journal of Nursing Administration, March 2018
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Clinically minded
volunteers meet
with patients and
families
Shared decision
making tools
Patient activation
measures
Open visiting
hours/rounding
White boards
Patient education
videos
Clinical nurse
leader rounding
Bedside charting
that enables
patient access
Code Lavender
Best Practices
Hassmiller and Bilazarian, 2018
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Inviting families to participate in
rounds:
• Supports their involvement in
decision-making
• Gives them an opportunity to ask
questions and share information
• Engages them as partners in the
care of their family member
• Improves safety and quality
Including Families on Rounds
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Rounds Without Patient and Family
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Rounds With Patient and Family
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What Matters to You Today?
www.whatmatterstoyou.scot/
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Best Practice: Organizational Change
Changing
workplace
culture
• Establish shared set of expectations
between providers and patients and
their families
Strong
nursing
leadership
• Need singular, consistent, and visible
leadership for organizational change
Engaged
staff
• Ingrain values and mission of
organization in each employee’s sense
of purpose
Hassmiller and Bilazarian, 2018
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• Time and need for efficiency*
– *Reframe to consider it a means
towards more effective clinical
care
• Technology**
– Use open charting and
educational videos
• Hesitation and fear***
– Invite patients and families to
play a role in their care
Barriers to Positive Patient Experiences
*Bishop, JP, Perry JE, Hine A. Efficient, Compassionate, and Fractured: Contemporary Care in the ICU. Hastings Center
Report 2014; 44(4): 35-43
**Zhang, J, Chen Y, Ashfaq S., et al. Strategizing EHR Use to Achieve Patient-centered Care in Exam Rooms: a Qualitative
Study on Primary Care Providers. Journal of the American Medical Informatics Association. Oxford Academic. OUP Academic.
Published November 13, 2015
***Bear, RA, Stockie, S. Patient Engagement and Patient-centered Care in the Management of Advanced Chronic Kidney
Disease and Chronic Kidney Failure. Canadian Journal of Kidney Health and Disease. Published October 21, 2014
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• Long hours
• Large caseloads
• Regulations and documentation
• Reimbursement pressure
• Physician and nurse shortages
• Patient complexity and acuity
• New technology
• Unsupportive work environment
Caregivers Also Suffer
Many are overworked, exhausted and unhappy
Dempsey, 2018
Kovner, C. T., & Brewer, C. S. (2011). RN work project. Robert Wood Johnson
Foundation. Retrieved from http://rnworkproject. org
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• When nurses recommend their
place of work, patients are also
more likely to recommend the
organization as a place when
care is needed*
• When workplaces reward
compassionate acts and support
staff during tough times, more
patients rate the care they
experience highly**
Patient and Caregiver Suffering Are
Connected
Takeaway: Reduce
caregiver suffering,
and you reduce
patient suffering
*Dempsey, 2018
**McClelland, Laura E., and Timothy J. Vogus. "Compassion practices and HCAHPS: does rewarding and
supporting workplace compassion influence patient perceptions?." Health services research 49.5 (2014):
1670-1683
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Reducing Caregiving Suffering
• Health leaders should acknowledge the complexity and
gravity of the work provided by caregivers
• Management should offer material, human and emotional
resources
• Teamwork is vital to success
• Empathy and trust should be fostered and modeled
• A positive work-life balance reduces compassion fatigue
• Communication is crucial
Dempsey, 2018
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Healthy Work Environments
Fontaine, D. K., Haizlip, J., & Lavandero, R. (2018). No Time to Be Nice in the
Intensive Care Unit. American Journal of Critical Care, 27(2), 153-156
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Best Practice: Interprofessional
Collaboration
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1. Put patient first
2. Demonstrate leadership
commitment
3. Create level playing field
4. Cultivate effective team
communication
5. Explore use of organizational
structure
6. Train different disciplines
together
Best Practice: Interprofessional
Collaboration
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Breaking the Rules for Better Care
Berwick, D. M., Loehrer, S., & Gunther-Murphy, C. (2017). Breaking the rules for better care.
Jama, 317(21), 2161-2162
Top Ideas for Improving Patient Care:
1. Eliminate visiting hours. Enable family members to visit
as often as they want
2. Change CMS rule to allow patients to be transferred to
skilled nursing facility without waiting for three days in an
inpatient facility
3. Allow each member of the care team to operate at top of
license to improve patient flow
4. Make same-day appointments available
5. Reduce waiting times
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Key Takeaways:
• Prioritize compassion from the C-suite on down
• Adopt best practices to promote consumer engagement
• Support staff to reduce caregiver suffering
• Promote interprofessional care and strong teams
• Change rules that detract from the care experience
What Nurse Leaders Can Do
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-- Maya Angelou
I’ve learned that people will
forget what you said, people will
forget what you did, but people
will never forget how you made
them feel
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Thank You!
